Uluru, also known as Ayers Rock, is a geological feature at the heart of Australia with huge cultural significance to people living there. For indigenous Australians, it is holy ground, representing millenia of history, mythology, and their symbiotic relationship with the land. Every inch of this awe inspiring rock is celebrated, represented, and connected with places far and wide across Australia through the “song-lines” which unite and re-unite people over time. Uluru is the ultimate Memory Space and a focus of healing for the peoples of Australia, both ancient and recent. In Africa we say “Umuntu ngumuntu, ngabantu” which means “a person is a person because of other people”. This finds expression in traditional African values around community and belonging. Psychologically, it is both constraining and liberating to hold this value. As individuals, we could feel smothered by a sense of responsibility for others or the demands of others. Yet, the knowledge that our very individuality is gathered by, with and for others infuses life with meaning and hope. This is especially true when illness, injury or loss shake up our ordinary lives until nothing is “normal” any more. Recently C, a wise and creative patient introduced us to the technique of the “memory space” as a guide and support through the process of cancer diagnosis and medical treatment. The idea was to use a dedicated space in her own home, to represent the experience of being diagnosed with breast cancer and of going through surgery. By inviting people who counted in her world, and who were interested in helping to create this special space, C began to share the burden of having cancer, as well as the hopes she had for the next steps in her journey with cancer. C has kindly given us permission to share this initiative via our website. It is a valuable exercise not only for recently diagnosed cancer patients but for anyone who is facing a personally devastating change or loss – whether that be divorce, illness, emigration or bereavement. Of course, it’s not easy to talk about cancer to others – especially when you’re still trying to get your own head around the news. The story is often shared with a chosen few; who usually try to respond in loving and supportive ways (though see our post on What Not to Say to Someone Who Has Cancer). C’s many years of experience and research in psychotherapy alerted her to the knowledge that more is possible – a deeper experience of Ubuntu and of love. Those invited to the ceremony were encouraged to bring whatever they felt moved to share: a note, a card, a piece of writing or music, a picture, an...

As the former director of French breast-prosthesis company Poly Implant Prosthese (PIP) contemplates the hefty jail sentence that he and his cohorts have just received for selling defective breast implants around the world, it may be time for a closer look at implants and how best to live with them. A breast implant is not just for Christmas – it’s a long term commitment, yet not a “happily ever after” that you have done and never have to bother with again. In recent years, encouraged by the “extreme make-over” culture, the eye-popping silicone-enhanced bosoms of squadrons of celebs and the greater affordability of cosmetic procedures, breast enhancement has taken off in unprecedented ways. Not everyone is thrilled with this, however. Last year a survey in Britain showed a high level of concern about the marketing of “cut price” surgery: “The proliferation of advertising for cosmetic surgery and its use in TV make-over programmes was felt to trivialise surgery and its risks, while making excessive claims of its impact on people’s emotional well-being” – Sir Bruce Keogh, summarising responses from the public in December 2012. For women undertaking surgery for cancer, the situation can be even more difficult. After all, cancer did not wait for you to choose a ‘new look’ or even to research the options. Cancer restructures you without permission! The fact is that women’s bodies, especially our breasts, are an emotive issue – not only for individuals but for society in general. The only people with a simple attitude to the female breast are breast-fed babies, for whom the breast is comfort and survival. For the rest of us, it’s complicated…. Controversy over dangers posed by silicone implants, whether sub-standard or not, continues to rattle around the blogosphere. On the one hand, a recently released research report found no scientific evidence that silicone gel is more than a nuisance factor, even if it leaks into local tissue and/or is transported away from the breast. Women, however, are unique individuals and complex, unexpected emotions can follow breast implantation including constant irritating awareness of the implants, anxiety, breast pain and difficulty sleeping (especially if you are a stomach or side sleeper). Symptoms such as pain must be taken seriously because it could be a low grade infection (see below). Saline (salt water) implants are an alternative to silicone, but they are prone to collapse and don’t feel like natural breast tissue, which makes them less popular with breast surgery patients. So what is a woman to do? Cosmetically, the results of early breast reconstruction can be excellent, which is a huge help in getting your confidence back after a cancer scare. And, the world is what it is. Not...

Being diagnosed with breast cancer and undergoing mastectomy can be a traumatic experience, and surgeons are often consulted about “prophylactic” mastectomy – a procedure to remove the healthy breast along with the cancer-affected breast in the hope of avoiding a recurrence of breast cancer at a later stage. Researchers at the University of Minnesota have found that the “survival benefit” for this procedure is less than 1% at 20 years post-surgery – at least, for patients who do not have the BRCA gene mutation. According to Medscape, their findings were presented recently at the American College of Surgeons 2013 Annual Clinical Congress. The increasing demand for the procedure is surprising in itself, given that not so long ago most patients dreaded the removal of a breast and would not wish to consider the loss of both breasts if one, at least, was healthy. Now, it seems that as many as one in five women are undergoing double mastectomies despite having a normal lifetime risk and a healthy other breast. What has changed? It’s not entirely clear but may have to do with the increasing recognition and awareness of breast cancer in society as well as publicity around public figures who opt to have prophylactic mastectomies earlier in 2013. Film star Angelina Jolie is a case in point, whose life chances have been substantially improved because she was found to have the BRCA mutation after two close female relatives developed breast cancer. In cases like Angelina’s, prophylactic mastectomy is worthwhile, even though no cancer has yet been diagnosed. Women are also aware that surgical management of the breast has improved dramatically in the past couple of decades and that cosmetic outcomes are often very acceptable with modern reconstruction techniques. However, the new computer model which predicts the likelihood of long term survival of patients who have had breast cancer but do not have the high-risk BRCA mutation suggests that for most patients there is little to be gained in terms of risk reduction, by removing the healthy breast. The research compared risks for breast cancer occurring in the other breast, and chances of survival with and without prophylactic mastectomy, in women aged between 40 and 60 who had been diagnosed with early-stage breast cancer but were without the BRCA mutation. The analysis also took into account age, how much the original breast tumour had grown before diagnosis (Stage I or II), and also the extent of oestrogen receptor involvement. According to this model, a person at the lowest risk for recurrence of breast cancer (i.e. younger, with a Stage I tumour, and oestrogen-receptor negative), might hope (on average) to gain an approximate extra 6 months of life. An older patient...

Physiotherapist guidance for arm activity following breast surgery Check with your doctor about relative restrictions on exercises following surgery, although most exercises can start on the day after surgery. Your surgeon may request a physiotherapist to help you with some of the exercises initially. It may take two to three months for you to recover full use of your arm. If you are having specific problems with moving your shoulder, ask your doctor regarding a referral to a physiotherapist. Shoulders are made to have full movement and your arm will feel best when this is achieved. You are encouraged to use your elbow and hand as much as possible, within the limits of your pain, from as soon as you can after surgery. For the first few days following surgery, deep breathing exercises are advised. Lie on your back and breathe in until your lower chest expands, then exhale and relax. Repeat three or four times to help you relax and also gently expand your chest on the operated side. “Normal” shoulder movement implies that you have the ability to reach across the top of your head to touch the opposite ear without a stretchy feeling in you armpit (axilla). Use this as a guide to measure your progress. Shoulders are made to have full range of movement, and you will probably only feel comfortable once you have reached your normal. Generally, it is okay to stretch your shoulder until you feel a mild pull, but no pain. Stretches should always be done slowly and smoothly. You can stretch up to three times a day. Consult your doctor or physiotherapist if you are unsure. The stiffness and tightness in your chest after surgery and radiation therapy will come and go for a while. Start with activities that will assist your normal day-to-day activities: reach into cupboards, wash and dry your hair, fasten your bra. After the stitches have been removed and the wound has healed fully, you may start massaging the scar for approximately 10 minutes after a warm bath or shower. Use circular movements to cover the scar and surrounding areas, to ensure optimal flexibility of the scar tissue. If swelling persists after surgery, elevate the arm at a 45º angle on pillows. Apply heat packs (warm, not hot) to the limb, and do pumping exercises with the...

Lymphoedema is an accumulation of excess fluid in any body part that has experienced damage to the lymphatics. After breast cancer, it is generally characterised by swelling of the hand, arm, breast, or torso on the affected side and is associated with significant physical, functional, psychosocial, and economic burden for those who develop this chronic condition. The lymphatic system is a network of glands connected throughout the body by tiny vessels called lymph vessels. Lymph vessels contain lymph. Lymph is a yellow fluid with cells called lymphocytes. Lymphocytes help fight disease. The lymph flows through the lymphatic system and eventually drains into veins. This system helps to get rid of waste products from the body. Lymphoedema is associated with surgical removal of lymph glands and radiation to the axilla. Being overweight in combination with surgery and radiation increases your chances of getting lymphoedema, so watch your weight. Lymphoedema occurrence after breast cancer treatment is estimated up to 70% and is diagnosed as late as 30 years after treatment. Early recognition and treatment of lymphoedema provide optimal outcomes and may alleviate or minimize the physical and emotional burden. Lymphoedema measurement should be done on diagnosis of cancer, before or immediately after breast cancer surgery, as a baseline measurement. Some of the signs of developing lymphoedema in your arm is a “feeling of heaviness” in the arm, a “feeling of tightness” (garments and/or jewellery), and greater difficulty with movement and daily activity. If the surgery involved removal of some or all of your lymph glands, or when you undergo radiation to your axilla, you may be at risk to develop lymphoedema. The average time of onset is approximately 3½ years, but it may start earlier or even a lot later. Guidelines to help prevent lymphoedema Minimize restrictions to lymph flow Restricting lymph flow slows clearance of fluid from the limb. Assist by not wearing tight bra’s, tight sleeves, tight jewellery, etc. Carry handbags on your non-compromised shoulder, and avoid sleeping on your operated arm if possible. Minimize exposure to heat Overheating causes the body to produce extra fluid which can build up in the limb. Avoid saunas, spa’s, long hot showers, excessive exercise, sprains and bruises. Take care in climates with high humidity. Avoid direct heat from heaters, open fires or electrical blankets left on, directly over the affected limb. Minimize sustained muscle tension Keeping your muscles contracted for any length of time (like when carrying heavy objects) can trigger lymphoedema. Repetitive actions like typing, piano playing, driving long distances, painting the house, gardening could also be culprits. Do everything in moderation. Medical treatments and your compromised limb Avoid having injections in, or blood taken from the affected limb unless it...

The majority of women diagnosed with breast cancer will require surgery and for those who need a mastectomy, many choose to go on to have breast reconstruction. Physiotherapy plays an important role in recovery after breast cancer surgery. Physiotherapy treatment is aimed at restoring and maintaining normal, pain-free movement. Some women will also require radiotherapy after surgery and physiotherapy can help women regain the movement in the arm needed to be comfortable in the position this treatment is given in. Physiotherapy services for breast cancer treatment patients pre-operative and post-operative assessment (to attain baseline information on the shoulder and arm, and provide the patient with education regarding exercise and lymphoedema) education on the physical effects of breast cancer treatment and how to minimize post-treatment complications customized post-surgical rehabilitation programmes, based on the phase of breast cancer treatment, to restore range of motion, strength, aerobic capacity and function creation of individual home exercise programmes, with regular reassessment of progress and modification of the programme as needed instruction in scar mobilization techniques simple self-massage technique home care and education Who would benefit? Patients who have received medical treatment for breast cancer including: surgery (mastectomy, lumpectomy, axillary dissection, reconstruction) radiation chemotherapy hormonal therapy Possible physical side effects of breast cancer treatment pain decreased shoulder range of motion decreased upper extremity muscle strength decreased cardiopulmonary function soft tissue fibrosis fatigue axillary web syndrome / lymphatic cording syndrome, which is inflammation of the lymph vessels sensory loss neuropraxia lymphoedema (see later) backache, poor posture and reduced function psychosocial impacts: anxiety, depression, fears, concerns, changes in life patterns, adjusted activity These possible side effects may be reduced with education and a customized, safe exercise programme designed by a knowledgeable physiotherapist. Physiotherapists are experts in addressing these issues and can provide advice and treatment to ensure optimal recovery and promote return to normal function. Positive effects of exercise after breast cancer surgery improved quality of life improved cardiopulmonary function improved upper extremity range of motion improved upper extremity strength decreased fatigue improved venous and lymphatic flow improved functional abilities lower risk of death from breast cancer Research studies have identified a strong association between lower levels of physical activity and higher cancer mortality. Physical activity, such as walking or cycling an average of 30 minutes / day, can improve cancer survival by 33%....